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Standardized Process Used in the Emergency Department for Pediatric Oncology Patients With Fever and Neutropenia Improves Time to the First Dose of Antibiotics

Cash, Thomas MD, MSc*; Deloach, Traci RN; Graham, James MD; Shirm, Steven MD; Mian, Amir MD

doi: 10.1097/PEC.0000000000000077
Original Articles

Objectives This study aimed to evaluate the effect of a standardized process on time to the first dose of antibiotics in pediatric oncology patients presenting to the emergency department (ED) with fever and neutropenia (F-N).

Methods A standardized process and order set were created to be used on all pediatric febrile neutropenic patients who presented to the ED of a large academic children’s hospital. The order set was used for patients with a known oncologic diagnosis, a fever greater than 38.3°C, and who were presumed or known to be neutropenic. A retrospective chart review was then performed for the 18 months before and the 6 months after implementation of the new process to evaluate if the time to the first dose of antibiotics was significantly reduced.

Results A total of 130 occurrences of F-N were analyzed. This included 100 episodes before the implementation of the new process and 30 episodes afterward. The time to antibiotics being ordered was reduced by over half, with a median time of 72 minutes preprocess and 27 minutes postprocess implementation (P = 0.04). Median time from the arrival in the ED to the administration of the first dose of antibiotics was reduced by almost an hour, taking 154 minutes before the new process compared with 95 minutes after its implementation (P = 0.0001).

Conclusions The use of a standardized process that uses a standardized order set can reduce the time to the first dose of antibiotics in pediatric oncology patients with F-N.

From the *Department of Pediatrics, Emory University, Atlanta, GA; and †Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.

Disclosure: The authors declare no conflict of interest.

Reprints: Thomas Cash, MD, Emory Children’s Center, 2015 Uppergate Dr, 4th Floor, Atlanta, GA 30322 (e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.